Riverbend

Customer Service FAQ

I filed a hardcopy claim and got my claim back with a paper indicating there was something wrong with the type of bill.  But I don't see anything wrong with it.

Hardcopy claims must have four digits.  Ensure a leading zero is preceding your normal 3 digit type of bill. (09/30/2008)

Can FL 51 and/or FL 57 be populated?

No, both form locators 51 and 57 should be blank. (09/30/2008)

When should condition code 08 be used?

Condition code 08 is used when the beneficiary would not provide information concerning other insurance coverage. (09/30/2008)

I received my remittance advice, but not the associated check. Who can help me?

The provider reimbusement area will be able to assist you. They can verify the check issued and will be able to advise if there is any withhold on your facilities accounts. Provider Reimbursement can be contacted via telephone at 877-484-1134, select Option 5. (7/11/2007)

Why can't a Customer Service Representative provide me with a patient's benefits and elegiblity information?

CMS has mandated that provider utilize the tools provided for them, "Providers shall be required to use IVRs to access claim status and beneficiary eligibility information.." CMS IOM, 100-9 Ch6 Provider Customer Service Program, section 50.1

RGBA's IVR (Interactive Voice Response) offers this information to providers 24/7 and may be contacted at 1-877-296-6189. Instructions for the IVR. (7/11/2007)

How do I identify the beneficiary's liability on a claim?

For covered Medicare services, the deductible and co-insurance section of the Remittance Advice (RA) will advise you on what you are able to bill to the beneficiary. If there is a zero amount in those fields, then the beneficiary is not responsible for the charges. (7/11/2007)

Why doesn't the IVR give me information on claims in location code RB7516

RB7516 is a Post-Pay Review location. THE IVR is not able to offer additional information while the claim is in that review location; however, we are working on forthcoming enhancements to improve that process. (7/11/2007)

We are having difficulty getting our claims through now that we are submitting them with our NPI. Why is this, and what can we do to fix the issue?

Much of the time we are finding there is a descepancy between information that was entered in the NPPES website and what we have on file.

For claims returned to providers (RTPs) due to your NPI not listed on the Crosswalk the following steps may help to resolve this issue:

1. If you are using a Vendor or clearinghouse to submit your claims, verify that your data is not being altered prior to claims submission. If the data is being transmitted to Riverbend correctly:

a. Verify your facility information provided to NPPES (i.e., facility name, address, zip code and TIN) through the NPPES Web site. If the TIN is not correct on the NPPES Web site, you will need to screen print the data found on the Website, (for your records) and contact NPPES by phone at 1-800-465-3203 (NPI Toll-Free) or 1-800-692-2326 (NPI TTY); by email at customerservice@npienumerator.com or by mail at NPI Enumerator, PO Box 6059, Fargo, ND 58108-6059 to have the data corrected.

If the information is correct with your vendor AND on the NPPES Web site:

b. Verify that the TIN on the Fiscal Intermediary Shared System (FISS) is the same as the information on the NPPES Web site. If the TIN is not correct on FISS, you will need to determine what the correct information actually is, then file an 855A with RGBA. You can access the form at the following Web site: http://www.cms.hhs.gov/CMSForms/CMSForms/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS019475.
The 855A completion process by Riverbend could take up to sixty (60) days to be completed.

2. If the information on NPPES and FISS are correct, please call our service line at the telephone number indicated below. Please have your screen prints from the Riverbend we will forward the issue to The CMS. (7/11/2007)